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Trusts are also reducing the availability of some procedures on the NHS, including hip and knee replacements, IVF treatment and plastic surgery.

Four private healthcare companies contacted by the GP newspaper Pulse have seen a dramatic rise in business from patients who do not have medical insurance but have chosen to pay for themselves to avoid blocks placed on GP referrals.

Spire Healthcare, which runs 37 private hospitals, saw a 10 per cent year-on-year increase in the number of self-pay ‘clinically necessary procedures’ it carried out in October.

Enquiries about self-pay procedures rose by 33 per cent between August and November.

Nuffield Health, which has 30 private hospitals, has had a big increase in self-pay treatments this year, particularly for orthopaedics and plastic surgery.

BMI Healthcare, which describes itself as ‘Britain’s leading provider of independent healthcare’, said it has seen a ‘continued and steady’ increase in the number of self-pay procedures.

And at Ramsay Health Care, self-pay cases have risen by 5 per cent in the last six months. Industry-wide figures suggest that on average 150,000 patients each year pay for their operations, with the latest figures reversing a falling trend.

Dr Jean-Jacques de Gorter, clinical services director at Spire Healthcare, said: ‘The increase in enquiries about private treatment is largely the result of changes we’re seeing in the healthcare system. NHS funding can only stretch so far.’

Katherine Murphy, chief executive of the Patients Association, said: ‘It is disgraceful that patients feel they must go private to get the treatment they need.’

A Department of Health spokesman said: ‘If a treatment or procedure is clinically necessary then that person should be able to receive it on the NHS.

‘That’s why we announced firm action recently to ban non-clinical rationing measures imposed on patients that don’t take account of their individual clinical needs by March 2013.’